Needs assessment in long-term care: expression of national principles for priority setting in service allocation

Background Long-term care services for older adults are characterised by increasing needs and scarce resources. Political strategies have led to the reorganisation of long-term care services, with an increased focus on “ageing in place” and efficient use of resources. There is currently limited research on the processes by which resource allocation decisions are made by service allocators of long-term care services for older adults. The aim of this study is to explore how three political principles for priority setting in long-term care, resource, severity and benefit, are expressed in service allocation to older adults. Methods This qualitative study uses data from semi-structured individual interviews, focus groups and observations of service allocators who assess needs and assign long-term care services to older adults in Norway. The data were supplemented with individual decision letters from the allocation office, granting or denying long-term care services. The data were analysed using reflexive thematic analysis. Results The allocators drew on all three principles for priority setting when assessing older adults’ long-term care needs and allocating services. We found that the three principles pushed in different directions in the allocation process. We identified six themes related to service allocators’ expression of the principles: (1) lowest effective level of care as a criterion for service allocation (resource), (2) blanket allocation of low-cost care services (resource), (3) severity of medical and rehabilitation needs (severity), (4) severity of care needs (severity), (5) benefit of generous service allocation (benefit) and (6) benefit of avoiding services (benefit). Conclusions The expressions of the three political principles for priority setting in long-term care allocation are in accordance with broader political trends and discourses regarding “ageing in place”, active ageing, an investment ideology, and prioritising those who are “worse off”. Increasing attention to the rehabilitation potential of older adults and expectations that they will take care of themselves increase the risk of not meeting frail older adults’ care needs. Additionally, difficulties in defining the severity of older adults’ complex needs lead to debates regarding “worse off” versus potentiality in future long-term care services allocation. Trial registration Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-024-10889-1.

In the "Methods" section, under the heading "The interviews" on page 13. 2. Credentials.What were the researcher's credentials?E.g.PhD, MD In the "Methods" section, under the heading "The interviews" on page 13.

Occupation. What was their occupation at the time of the study?
In the "Methods" section, under the heading "The interviews" on page 13. 4. Gender.Was the researcher male or female?
In the "Methods" section, under the heading "The interviews" on page 13.

Experience and training. What experience or training did the researcher have?
In the "Methods" section, under the heading "The interviews" on page 13.

Relationship with participants
6. Relationship established.Was a relationship established prior to study commencement?
In the "Methods" section, under the heading "Recruitment and participants" on page 12.
7. Participant knowledge of the interviewer.What did the participants know about the researcher?e.g.personal goals, reasons for doing the research.
In the "Methods" section, under the heading "Ethical approval and consent to participate" on page 15.
8. Interviewer characteristics.What characteristics were reported about the interviewer/facilitator? e.g.Bias, assumptions, reasons and interests in the research topic.
In the "Methods" section, under the heading "The interviews" on page 13.

Theoretical framework
9. Methodological orientation and Theory.What methodological orientation was stated to underpin the study?e.g.grounded theory, discourse analysis, ethnography, phenomenology, content analysis.
The conceptual framework is presented in the Method section under the heading "Conceptual framework" on page 9.The methodology is described in the "Methods" section under the heading "Design" on page 12 and under the heading "Coding and data analysis" on page 15.
In the "Methods" section, under the heading "Recruitment and participants" on page 12.
11. Method of approach.How were participants approached?e.g.face-to-face, telephone, mail, email.
In the "Methods" section, under the heading "Recruitment and participants" on page 12.
12. Sample size.How many participants were in the study?
In the "Methods" section, under the heading "Recruitment and participants" on page 12.
13. Non-participation.How many people refused to participate or dropped out? Reasons?N/A Setting 14. Setting of data collection Where was the data collected?e.g.home, clinic, workplace.
In the "Methods" section, under the heading "The interviews" on page 13.
15. Presence of non-participants.Was anyone else present besides the participants and researchers?
In the "Methods" section, under the heading "Observation and informal conversations" on page 13.
16. Description of sample.What are the important characteristics of the sample?e.g.demographic data, date.
In the "Methods" section, under the heading "Data collection" on page 12-14.

Data collection
17. Interview guide.Were questions, prompts, guides provided by the authors?Was it pilot tested?
In the "Methods" section, under the heading "The interviews" on page 13.In the "Methods" section under the heading "Coding and data analysis" on page 15. 20.Field notes.Were field notes made during and/or after the interview or focus group?
In the "Methods" section, under the heading "Observation and informal conversations" on page 14.

Duration. What was the duration of the interviews or focus group?
In the "Methods" section, under the heading "The interviews" on page 13.

Data saturation. Was data saturation discussed?
In the "Methods" section, under the heading "Recruitment and participants" on page 12.In the "Methods" section under the heading "Coding and data analysis" on page 15.
25. Description of the coding tree.Did authors provide a description of the coding tree?
In "Table 1" on page 42-44.26.Derivation of themes.Were themes identified in advance or derived from the data?
In the "Methods" section under the heading "Coding and data analysis" on page 15. 27.Software.What software, if applicable, was used to manage the data?
In the "Methods" section under the heading "Coding and data analysis" on page 15.
28. Participant checking.Did participants provide feedback on the findings?N/A Reporting 29.Quotations presented.Were participant quotations presented to illustrate the themes / findings?Was each quotation identified?e.g.participant number.
Throughout the "Results" section and described in "Table 1" on page 44 and in the "Method" section under the heading "Individual decision letters" on page 14. 30.Data and findings consistent.Was there consistency between the data presented and the findings?

Yes.
31.Clarity of major themes.Were major themes clearly presented in the findings?

Yes.
32. Clarity of minor themes.Is there a description of diverse cases or discussion of minor themes? Yes.
18. Repeat interviews.Were repeat interviews carried out?If yes, how many?N/A 19.Audio/visual recording.Did the research use audio or visual recording to collect the data?
23. Transcripts returned.Were transcripts returned to participants for comment and/or correction? of data coders.How many data coders coded the data?